Volume 51 · Issue 07 · 2015

The formulation on the eye health by WHO had an obvious change in recent years. Before 2006, WHO and WHA solutions clearly put forward the prevention of blindness. After 2006, WHO and WHA solutions on the eye health emphasized the elimination of the avoidable blindness and visual impairment. This change extends the scope of eye health, reflects the important progress on the global eye health, and also reflects the social progress and the increase to the need on eye health by the public. This change conforms to the actual situation in China. It is necessary to adopt elimination of the avoidable blindness and visual impairment as the priorities in eye health in making the 13th national plan of blindness prevention. This change is not merely a matter of wording, but also a great change in the working content in eye health. The change demonstrates the deep development on the eye health, and may benefit more people and promote the further development of eye health and ophthalmology in China. (Chin J Ophthalmol, 2015, 51: 481-483)

Trachoma had been the leading infectious cause of blindness. After years of hard work and unremitting efforts, blinding trachoma would never been a public health problem in China by 2015. Discovery and research of Chlamydia trachoma provide a scientific way for the prevention and control of trachoma. The achievement of eliminating blinding trachoma in China pertained to the highly concerned about government and succeed spreading of SAFE strategies. It is still required to strengthen the diagnostic criteria and knowledge training of public health disease. Epidemiological investigation should follow the international criteria. Though blinding trachoma would never been a public health problem in China, comprehensive prevention and control of trachoma should be emphasized in case of being epidemic again. (Chin J Ophthalmol, 2015,51: 484-486)

The purpose of the study is to determine the prevalence of appositional angle closure in persons aged 50 or above in Funing County.

Cluster sampling randomly selected residents in Funing County aged 50 years or above. From March to May 2010, 484 eyes of 243 patients with the shallow peripheral anterior chamber and the anatomic narrow chamber angle, which was determined by Van Herick technique and gonioscopy, were collected from 5202 individuals. The presence of appositional angle closure and the angle-opening distance(AOD) was determined with photopic and scotopic ultrasound biomicroscopy(UBM) in eight positions. Paired χ ² test and paired t test(SPSS 17.0) were used to determine any significant differences at P<0.05.

The prevalence of appositional angle closure was found at least one position in 337 eyes(69.6%) by scotopic UBM and in 116 eyes(24.0%) by photopic UBM. The prevalence of appositional angle closure was significantly higher by scotopic UBM than by photopic UBM(χ²=204.36, P<0.001 respectively), and was the highest in superior quadrant. The AOD varied significantly among the eight positions and was significantly narrower by scotopic UBM than by photopic UBM (t=6.039, 6.883, 11.612, 11.157, 4.732, 6.798, 5.156, 4.071; P<0.001). Since 197 persons(81.07%) were found anterior angle closure by scotopic UBM, we estimated the prevalence of appositional angle closure was 5.40% (95%CI: 4.80%-6.05%)among adults aged 50 or above in Funing County.

The prevalence of appositional angle closure was higher than previous surveys, the possible reason is that scotopic UBM could find early appositional angle closure more preferably. (Chin J Ophthalmol, 2015, 51:487-492)

To investigate the status of eye disease prevention resources in community health service centers, to understand the distribution of ophthalmology service resources in each community, and to understand the main problems existing in the work of blindness prevention and treatment in Shanghai, so as to strengthen the prevention of blindness and improve the primary eye care level.

Using the survey method, we carried out the investigation of disease control and prevention resources in all community health service centers to obtain the data of eye disease prevention and treatment resources. Using the descriptive statistics, we described the distribution of resources of eye disease prevention and treatment in different districts.

There were 244 communities in 17 districts and counties in Shanghai, of which 236 (96.72%) communities participated in the survey and completed the questionnaires. Forty-nine (20.8%) communities had independent outpatient departments of ophthalmology, 96 (40.7%) had departments of ophthalmology and otorhinolaryngology, 33 (14%) had ophthalmology doctor visits from secondary or tertiary medical institutions, and 87 (36.9%) had no outpatient department of ophthalmology. There were 82 oculists, 129 general or otorhinolaryngology doctors treating eye disease, 9 ophthalmic nurses, and 1 optometrist. There were 36 specialized personnel for public health of eye protection and 217 part-time personnel. Moreover, there were a total of 1 103 pieces of ophthalmic equipment in all communities with the use rate of 91%.

Uneven ophthalmology resources and eye care professional ability in community health service centers, lack of technical and public health personnel for prevention of eye disease, backward eye disease screening equipment, and inadequate investment in prevention and treatment of eye disease are major problems. More government supports for prevention and treatment of eye disease in communities and continuous improvement in three-level blindness prevention network systems and information construction are needed. (Chin J Ophthalmol, 2015, 51: 493-498)

This survey is conducted by Hebei Society of Ophthalmology to understand the current situation of the department of ophthalmology in Hebei province, in order to help the Branch to develop an effective, highly-targeted and practical continuing education program.

A questionnaire is used in this survey, which consists of 4 sections and 25 items, covering Basic Information, Hospital and Department, Personal Practice and Open-ended Questions. The questionnaire is distributed and collected by the Society of Ophthalmology of each region in Hebei province to all medical institutions in their area which have the ability to carry out ophthalmic clinical work. After the aggregation of the questionnaire and according to the omission, Hebei Society of Ophthalmology contacts the individuals who missed the survey by direct calls, letter post and email, etc. to finish the survey.

This survey covers 121 counties and cities (coverage 85.8%), 305 medical institutions and 1 485 ophthalmologists. Results shows that trained ophthalmologists take a high proportion (84.3%) in all hospitals, the percentage of ophthalmologists who are eager to learn and improve is high (94.8%), the percentage of ophthalmologists having a Bachelor degree or above is high (68.9%). However, the percentage of ophthalmologists having a Master or Doctor degree is relatively low (19.6%), the talents who can independently carry out vitrectomy are insufficient (4.1%), the percentage of the medical institutions not having basic ophthalmic equipment is high (37.3%).

The reasons restraining the development of Ophthalmology in Hebei province include the lack of professional talents and ophthalmic equipment. The contradiction between the increasing demand of the public for ophthalmological treatment and the limited medical service level we can provide is the primary contradiction in the departments of Ophthalmology in Hebei province. After the survey and according to the results, Hebei Society of Ophthalmology will organize more training to meet the desire and interest of the ophthalmologists in our province, to achieve the ultimately goal of improving the Ophthalmic medical level throughout the province. (Chin J Ophthalmol, 2015, 51:499-504)

To investigate the development of the refractive status in premature infants full-term children aged 0 to 6 years old.

Case control study. One thousand one hundred and sixty-four premature infants and One thousand one hundred and ninety-one full-term children were collected from September 2011 to September 2012 in Renmin Hospital of Wuhan University, among them, one thousand and eighty-eight premature infants premature infants (2 176 eyes) without retinopathy of prematurity (ROP) and one thousand one hundred and two cases of full-term children (2 204 eyes) were included in the study. Refraction with cycloplegic retinoscopy was determined. The corneal curvatures and axial lengths of premature infants aged 3 to 6 years old were measured by Optical coherence interferometry.

(1) The incidence of myopia and astigmatism were 9.1% and 35.4% in premature infants aged 0 to 6 years old, and 4.4%, 18.9% in full-term children. (2) The spherical diopter, cylindrical lens diopter and spherical equivalent degree were (1.15±0.87), (0.84±0.71) and (1.47±0.28) D, three types of refractive value reduced progressively along with increasing age.(3) Changes in spherical equivalent degree in preterm children are associated with axial length, corneal curvature, gestational age, birth weight and age (r=-0.232, 0.112, 0.117, 0.254, -0.215, P=0.000, 0.009, 0.008, 0.000, 0.001).

The incidence of myopia of premature infants without ROP was higher than that of full-term children; The emmetropization of premature infants begins earlier than full-term children. (Chin J Ophthalmol, 2015, 51:505-509)

To evaluate the changes of the contrast visual acuity (CVA) in early age-related cataract patients.

Case-controlled study. One hundred and four eyes of 52 age-related cataract patients, with the best corrected visual acuity equal to or more than 0.8, equivalent spherical diopters of -3.00 to 3.00 DS and astigmatic diopters of -1.50 to 1.50 DC, were selected as the cataract group. Another 104 eyes of 52 normal adults, with the best corrected visual acuity equal to or more than 0.8, equivalent spherical diopters of -3.00 to 3.00 DS and astigmatic diopters of -1.50 to 1.50 DC, were selected as the control group. They were paired according to sex, the similar age and the best corrected visual acuity. After eye and refractive examinations, all examinees received the CVA measurements in different contrast levels between the optotypes and background (100%, 25%, 10% and 5%) in the dark room by the multifunction visual acuity chart. SPSS 18.0 software package was used for paired t test.

In the cataract group, CVA decreased more significantly than the control group. OD: 0.99±0.26, 0.59±0.23, 0.38±0.19, 0.23±0.12. OS: 0.98±0.28, 0.59±0.18, 0.38±0.14, 0.23±0.10. OU: 1.15±0.26, 0.73±0.20, 0.49±0.16, 0.30±0.10 (OD: t=-6.49, -7.25, -7.57, -5.45. OS: t=-5.78, -7.51, -6.41, -7.16. OU: t=-4.33, -7.60, -7.53, -9.75, P<0.01) . There was a significant decrease in different degrees of cortical cataract (F_100%=50.18, P=0.000. F_25%=23.08, P=0.000. F_10%=20.17, P=0.000. F_5%=13.42, P=0.000). There was a significant decrease in different degrees of cortical cataract compared with the control group (C1: t=-6.49, -7.25, -7.57, -5.45, P<0.05. C2: t=-5.78, -7.51, -6.41, -7.16, P<0.01. C3: t=-4.33, -7.60, -7.53, -9.75, P<0.01) .

CVA was more reliable than the best corrected visual acuity in evaluating vision function in patients with early age-related cataract. (Chin J Ophthalmol, 2015, 51:510-514)

To investigate the long-term clinical effects of orthokeratology (ortho-k) in high myopia children with 5 years of follow-ups.

Prospective study. We chose 30 high myopia patients to wear ortho-k contact lenses (CLs) for controlling or delaying myopia progression from 2003. Among them, there were 10 boys and 20 girls whose average age was (15±2) years, spherical diopters were (-7.34±0.91)D, corneal astigmatism diopters were (-1.06±0.62) D, uncorrected visual acuity was LogMAR 0.89±0.29, corneal flattened curvature was (43.54±1.16)D, and axial length was (26.38±0.94)mm. All patients, with informed consent before fitting of ortho-k CLs, had conventional refraction and ocular tests. We compared the values of spherical diopters, visual acuity, corneal flattened curvature and axial length before and 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after wearing CLs, respectively. The results were analyzed by SPSS 16.0 software.

During the five years of observation periods, all patients' visual acuity and corneal flattened curvature were different from the pre-fitting (P<0.05). Compared to the pre-fitting, the naked visual acuity was some degree improved, it was LogMAR 0.45±0.31, 0.49±0.32, 0.43±0.30, 0.47±0.31, 0.58±0.35, 0.53±0.27,respectively. F=10.725, P=0.000. Corneal flatten curvature was tend to be flatter, such was 41.14±1.54, 41.75±1.88, 41.54±2.10, 41.73±1.89, 41.94±1.61, 40.70±1.67. F=10.161, P=0.000 (All P<0.05). The spherical diopters during the first two years after wearing ortho-k CLs were significantly reduced, compared with the previous values (it was -5.23±1.81, -5.59±2.75, -6.29±2.12, -6.63±2.31, -6.83±2.33, -7.01±1.81,respectively, F=4.929, P=0.000), and kept stable in the long-term observation. The axial length checked at 5 years was slightly elongated (it was 26.41±0.90, 26.68±0.93, 26.69±1.06, 26.75±0.94, 26.81±1.04, 27.04±1.01. F=1.831, P=0.094). The axial elongation was retarded by using ortho-k CLs in high myopia children. All patients were not subjected to severe complications which may lead to quitting the enrollments.

Orthokeratology used in controlling or delaying high myopia progression is definitely outstanding in 5 years observations. Standard lens wearing and regular lens check improve safety of lens use in high myopia. (Chin J Ophthalmol, 2015, 51:515-519)

To observe the changes of pathology and ultra-microstructure of corneal lenticules extracted by femtosecond laser small incision lenticule extraction surgery and to investigate instantaneous damage of photodisruption of femtosecond laser to human corneal tissue in vivo.

The small incision lenticule extraction surgeries in 25 myopic eyes were performed with Carl Zeiss VisuMax femtosecond laser, and the lenticules were observed by light microscopy, scanning electron microscopy and transmission electron microscopy.

Light microscopy showed slight edema in part of the collagen fibers in the cornea lenticule tissue. A thin layer of deep tissue dyeing at the edge of the lenticule was observed on a linear array. In the center of superficial lenticule tissue existed a few bubbles. Under the scanning electron microscope, the anterior surface of the lenticule was found to be relatively smooth, with no obvious tissue bridge. The posterior surface of the lenticule was slightly irregular compared with the anterior surface. Scattered tissue bridges and residual traces of the effect of femtosecond laser photodisruption could be observed. Under the transmission electron microscope, adjacent collagen fiber layers in the corneal lenticule matrix were detected to cross each other regularly, with no breakage of the collagen fibers or separation of the layers. The incision of the collagen fibers on one side of the lenticule was on a linear alinement. It can also be observed that the central part of the lenticule was mildly damaged. However, the stroma cells near the lenticule limbus were severely damaged. Part of the corneal stroma cells were solidified with several shivers, which might be due to the photodisruption. Some of the damaged corneal stroma cells were observed with remnants, while the spaces occupied by part of the corneal cells became fractured.

Obvious damage of the femtosecond laser to the corneal tissue at early stage was not observed. At the edge of the area where femtosecond laser focused, there were mild thermal injury and slight structure change. There were not abnormal appearances of the tissue structure at the non-focus area. (Chin J Ophthalmol, 2015, 51:520-526)

To investigate the change of refractive status in transgenic mice with mutant Lumican (bright proteoglycan) gene at different ages.

Experimental Study. Fifty-four 3-week-old with mutant Lumican gene (cDNA 596T>C) mice (27 male and 27 female) were randomly divided into 9 groups (n=6, half male and half female) by random number table. One group (3-week-old) was randomly chosen and measured the refractive status by retinoscopy after mydriasis. Measurement of other groups were repeated the method above respectively in the fourth, fifth, sixth, eighth, tenth, twelfth, sixteenth, and twentieth week. Differences of diopter between right and left eye and between male and female were compared within each group by paired t test. The differences of mice's diopters in different age were compared by Kruskal-WallisH test. Pairwise comparisons were acquired by Mann-Whitney U test.

There were no statistic difference of diopters between binoculus: The mice's diopters of right and left eyes were respective measured in the twentieth week (1.50±0.45) D and (1.25±0.42) D (t=-0.889, P>0.05), The mice's diopters of right and left eyes were respective measured in the third week (-2.50±2.59) D and (-2.50±4.32) D (t=0.000, P>0.05); There were no statistic difference of diopters between different genders: The mice's diopters of female and male were respective measured in the third week (-0.5±3.83) D and (-4.17±1.94) D, (t=2.079, P>0.05), The mice's diopters of female and male were respective measured in the twelfth week (1.50±0.84) D and (1.50±1.87) D (t=0.000, P>0.05); Analysis of binocular diopters revealed significant differences among nine groups (H=20.910, P<0.05) .Diopters measured in the third week (-2.50±3.40D) and the sixth week (+3.25±2.67)D had statistical difference (Z=-3.259, P<0.001) .There were no statistical significance between other groups (P>0.001).

Characteristics of diopters gathered from mice with Lumican gene mutation at different weeks are summarized as follows: Myopia could be observed in the third week. And this situation of myopia was gradually transformed into hyperopia with aging. The maximum hyperopic diopter was observed at 6th-week-old mice. From the eighth to twentieth week, the degree of hyperopic diopter gradually decreased and stabilized. (Chin J Ophthalmol, 2015, 51:527-531)

患者，男，65岁。因右眼下方黑影遮挡半个月于2011年2月24日来第四军医大学西京医院眼科就诊，门诊检查后以"右眼孔源性视网膜脱离"收入院。患者40年前患黄疸肝炎，已治愈。否认高血压、糖尿病病史。有轻度屈光不正，无其他眼病史。无手术史。眼科检查：视力：右眼0.25，左眼0.6。眼压：右眼13 mmHg（1 mmHg=0.133 kPa），左眼11 mmHg。右眼角膜透明，前房可，晶状体周边皮质混浊，玻璃体轻度絮状混浊，有少许色素状颗粒，眼底：视乳头边界清楚，颞上方视网膜呈青灰色泡状隆起，黄斑累及，颞上可见马蹄形裂孔，裂孔后缘稍有卷边，前缘可见广泛变性区（图1）。左眼前节及眼底检查未见明显异常。眼部B超示右眼颞上视网膜脱离，颞上可见视网膜裂孔，左眼未见视网膜脱离；双眼玻璃体混浊；双眼屈光不正。入院后于2011年3月1日在局部麻醉下行右眼巩膜外垫压术。术中颞上放液，裂孔周围冷凝，7 mm硅胶海绵纵行垫压裂孔及周围变性区，玻璃体腔内注入消毒空气0.4 ml。术后第1天患者诉眼前黑影消失。眼科检查：右眼视力0.2，眼压15 mmHg。眼底检查：玻璃体轻度絮状混浊，少量空气泡，颞上垫压嵴明确，裂孔位于嵴上，视网膜平伏。术后第7天，患者诉右眼下方再次出现黑影遮挡。眼科检查：右眼颞上垫压嵴可见，裂孔位于嵴上，裂孔后缘贴伏不良，鼻上视网膜青灰色泡状隆起，可见视网膜裂孔（图2）。B超示右眼颞上方垫压嵴，鼻上方视网膜脱离。左眼未见明显异常。2011年3月9日在局部麻醉下再次行右眼巩膜外垫压术。术中放液，鼻上裂孔周围冷凝，10 mm硅胶海绵纵行垫压鼻上裂孔，观察裂孔位于嵴上，褥式缝线固定。放液后发现11：30方位视网膜脱离皱褶处有新的裂孔，遂拟行颞上垫压带调整。当拆除原颞上垫压带后，突然感觉患者眼球变硬，眼压升高，并且出现剧烈眼痛，头痛症状。眼底检查见颞侧视网膜下棕色实性隆起。嘱患者张口呼吸，保持镇静，立即肌内注射立止血（注射用血凝酶）1 000 U。观察颞侧视网膜下隆起无明显进展，眼压适中，手术继续进行。加宽原颞上硅胶海绵，褥式缝线固定，观察原裂孔及皱褶处裂孔均位于嵴上，测光感明确。手术后静脉滴注地塞米松10 mg，降眼压及镇静对症处理。术后第1天，患者诉眼胀。眼科检查：右眼视力0.15，眼压：55 mmHg。右眼玻璃体轻度混浊。眼底检查：颞上及鼻上垫压嵴明确，裂孔位于嵴上，颞侧视网膜下可见球形实性隆起。对症观察，眼压稳定。术后第6天眼底照相显示较前无明显变化（图3）。复查B超示右眼视网膜复位良好，脉络膜上腔积血（图4）。术后门诊观察。1个月后复查见右眼上方垫压嵴明确，裂孔位于嵴上，孔周视网膜稍有皱褶，视网膜平伏，脉络膜上腔积血完全吸收（图5）。复查B超示右眼视网膜复位良好，脉络膜上腔积血吸收（图6）。补充视网膜激光光凝术，后门诊观察稳定。2011年8月24日患者因"右眼视物不清半个月"再次入院。诊断：右眼复发性视网膜脱离，右眼增生性玻璃体视网膜病变。眼科检查：视力：右眼光感，左眼1.0。眼压：右眼9 mmHg，左眼11 mmHg。右眼眼底检查：视网膜广泛青灰色隆起，以视乳头为中心呈宽漏斗状，颞上、鼻上垫压嵴明确，裂孔位于嵴上，裂孔后缘开放，嵴上色素明显（图7）。眼部B超示右眼视网膜脱离，右眼巩膜外垫压术后（图8）。入院后于2011年8月30日在局部麻醉下行右眼玻璃体切除术。术中全氟化碳液体辅助下玻璃体切除术联合晶体粉碎，注入硅油4.5 ml。术后早期视网膜复位良好，后复位不良致增生性玻璃体视网膜病变，眼内硅油存留。

The patient was a 47-year-old male. On June 8, 2014, he went to the ophthalmology clinic of Peking Union Medical College Hospital due to sudden nasal dark shadow occlusion of his left eye for 20 days. Previous myopia in both eyes-4.00~ -5.00 D. In 1982, the right eye underwent extrascleral compression due to retinal detachment. Eye examination: visual acuity: light perception in right eye, 0.02 in left eye; IOP: 18 mmHg (1 mmHg =0.133 kPa) in right eye and 6 mmHg in left eye. Anterior segment examination: Retrocorneal deposits (KP) in left eye (-), aqueous humor flash (+), planktonic body (+), opacity of lens, iris tremor in right eye, all white opacity of lens, partial cortical absorption. Fundus mydriasis examination showed opacity and concentration of the vitreous body in the left eye, broad funnel-shaped retinal detachment, and a 180° giant retinal hole on the temporal side (Figure 1）； The fundus of the right eye is invisible. B-mode ultrasound of the eye revealed wide infundibular retinal detachment in the left eye (Figure 2), partial retinal detachment in the right eye. Diagnosis: Giant hiatus retinal detachment in left eye, proliferative vitreoretinopathy, senile cataract. Myopia in both eyes. Cataract overmaturity in the right eye (with concurrent factors), retinal detachment after extrascleral compression, localized retinal detachment.

The patient was an 18-year-old female. Due to refractive errors in both eyes (the power of binocular lens is about-6.00 D), I underwent binocular LASIK operation under topical anesthesia in an external hospital on June 26, 2011. The naked visual acuity was 1.2 in the right eye and 0.25 in the left eye on the first day after operation. Because of the abnormal visual acuity of the left eye after LASIK, he went to the Department of Ophthalmology of the First Hospital of Jilin University 3 days after operation. Ocular examination: The cornea of the right eye is transparent, with a 3/4 ring mark of keratectomy. The corneal flap is intact, about 8.0 mm in diameter, with neat and regular edges, located at the optical center of the cornea, covering the pupil area, and the width of the corneal flap pedicle is appropriate. The corneal bandage piece of the left eye is in place, the cornea is transparent, and a 360° cut mark of keratectomy is visible. The corneal flap is about 6 mm in diameter, with irregular edges and no pedicle, located at the positive optical center of the cornea and covering the pupil area. The corrected visual acuity was 1.2 (0.75 DS) in the right eye and 0.25 (-1.50 DS) in the left eye after 30 min of removing the bandage2.25 DC ×5°). IOP: 9 mmHg (1 mmHg =0.133 kPa) in the right eye and 10 mmHg in the left eye position. The results of the corneal topography of the left eye are shown inFigure 1Middle A. Diagnosis: After LASIK in both eyes; Free corneal flap of left eye; Refractive error. Treatment: Left eye corneal flap-to-flap reduction was performed on June 30, 2011. Preoperative preparation is the same as conventional LASIK surgery. The operation process: under topical anesthesia, a long mark is gently made on the edge of the corneal flap at 12 o'clock and 9 o'clock each with a needle, the periphery of the corneal flap is lifted up with a flushing needle, and the whole corneal flap is separated from the stromal bed while flushing. The 12 o'clock mark of the corneal flap is slowly turned to the 9 o'clock position with a flushing needle, and the corneal flap is flattened and pasted with blood sucking sponge, and a bandage is worn. Tobramycetoxin dexamethasone eye drops point the left eye. After operation, 0.1% sodium hyaluronate and tobramycetoxin dexamethasone eye solution were routinely dripped 4 times/d. For postoperative conditions, seeTable 1The results of corneal topography examination at 1 d and 12 months after surgery are shown inFigure 1Medium B, C.

A 54-year-old female was seen in the Department of Ophthalmology of Peking University First Hospital on August 21, 2013 due to 2 d visual loss in her left eye. The patient had no family genetic history and no previous systemic history. Ophthalmological examination showed: naked visual acuity 1.2, Jr7 in the right eye, 0.1, Jr7 in the left eye, intraocular pressure 14 mm Hg in the right eye and 15 mm Hg in the left eye (1 mm Hg =0.133 kPa); Anterior segment examination of both eyes showed no abnormalities; There was no opacity in the vitreous cavity, the retina was in place, the color, border and shape of the optic papilla were normal, a:V =2:3, the foveal reflex in the right eye was visible, and there was no abnormality in the macular area. Scattered bleeding spots and small patches of bleeding were visible in the retina (FIG. 1A）。 The proliferative vascular membrane growing towards the vitreous body can be seen on the surface of the optic papilla of the left eye. Small tumor-like dilatation of the retinal artery at the optic papilla can be seen, a:V =1:2. The thickness of the arterial tube is uneven, the foveal reflex disappears, the epiretinal membrane with strong reflection can be seen at the posterior pole, and scattered punctate hard exudation and small patches of hemorrhage can be seen at the posterior pole and peripheral retina (FIG. 1B）。 OCT examination showed no abnormalities in the retinal structures in the macular area of the right eye (FIG. 2A）； The fovea of the left eye was flattened, the thickened retinal layer showed a hypo-reflective space, and the inner surface of the omentum showed a strong reflective band, which showed typical macular edema and epiretinal membrane (Figure 2B）。 ultra-widefield fluorescein angiography (UWFA) was performed after consultation. The arteriovenous filling of both eyes was normal, the surface of the optic papilla and the bifurcation of the retinal artery were tumor-like dilated, the posterior pole was scattered with fluorescence leakage foci, and the distal arteriovenous blood vessels were not filled, forming a large capillary non-perfused area. The ends of the blood vessels at the edges of the filling area were anastomosed with each other, and the serrated strong fluorescent edges were formed in the late stage. The late papilla of the right eye showed high fluorescence, and the neovascular membrane at the papilla of the left eye showed high fluorescence (Figure 3，Figure 4）。 Diagnosis: IRVAN syndrome in both eyes, macular edema in left eye, epiretinal membrane in left eye. The patient was consulted in the Department of Rheumatology and Immunology of Peking University First Hospital for blood routine, blood biochemistry, immune-related antibody, urine routine and carotid artery ultrasound. Only the antinuclear antibody (ANA) was positive with a titer of 1:320 (normal value<1:100), and no obvious abnormalities were observed. Consultation opinion: There is no systemic inflammatory reaction, and the increase of antinuclear antibody titer alone is not of diagnostic significance. Prednisone 40mg was administered orally, and binocular retinal laser photocoagulation was performed. Under the guidance of UWFA imaging, the fundus laser was extensively and thoroughly. UWFA reexamination at 2 and 6 months postoperatively showed that there were dense photocoagulation spots in the original non-perfusion area of both eyes, especially the laser spot in the anastomosis area at the end of the blood vessel (Figure 5）。 Reexamination of UWFA at 9 months postoperatively showed no significant progression in both eyes.

The patient was a 41-year-old male. Because my left eye itched for 1 d, I found two small white bugs when rubbing my eyes, and I went to the Department of Ophthalmology, the Second Hospital of Jilin University. The patient keeps farming cattle at home and has no other pets. Ocular examination: No obvious abnormalities were found in the anterior segment of the right eye; The conjunctiva of the left eye was congested, and a transparent linear worm was seen in the conjunctival sac near the lateral canthus of the temporal side, peristalsis and curling under the illumination light (Quintessence Picture 1), remove it with a cotton swab (Quintessence Picture 2), detailed examination of other positions of the conjunctival sac and lacrimal points without abnormalities. According to the parasitic site and morphology of the worm, the clinical diagnosis: Left conjunctival sucking nematode.

The patient was a 57-year-old female. Routine physical examination was performed in Changchun Aier Eye Hospital. Previous health, history of sulfonamide and penicillin allergy. Eye examination: visual acuity was 1.0 in both eyes; IOP was 13 mmHg (1 mmHg =0.133 kPa) in the right eye and 12 mmHg in the left eye; Anterior segment of both eyes normal; Irregular depigmentation of the macular area of the right fundus (Quintessence Picture 1), the autofluorescence image showed low fluorescence at the depigmentation of the macular area, and the OCT examination image was shown inQuintessence Picture 2； Left fundus normal. Clinical diagnosis: retinal pigment epithelial fovea in the macular area of the right eye.

In the past ten years, corneal endothelial keratoplasty has been widely and successfully performed in China. As an ideal surgical treatment for corneal endothelial diseases, Descemet's membrane endothelial keratoplastywas only tried out in few hospitals. This article summarized the development of Descemet's membrane endothelial keratoplasty in surgical indications, operation process and postoperative complications in China and abroad for providing references for clinical application.(Chin J Ophthalmol, 2015, 51: 544-547)

With development of the technology of cataract surgery, combined phacoemulsification and intraocular lens implantation in cataract with high myopia has been widely carried out in clinical treatment. Due to the particularity of high myopia, phacoemulsification in patients with cataract and high myopia is difficult and has recently received a lot of attentions. In this paper, preoperative examinations, the selection of intraocular lenses, surgery methods and surgical complications of cataract surgery in patients with cataract and high myopia are briefly reviewed. (Chin J Ophthalmol, 2015, 51: 548-551)

In clinical practice, maculopathy and neurological eye disorders often cause visual field defects. Once the defects are formed, treatment and rehabilitation are confronted with the bottleneck due to irreversibility. With the transformation of medical patterns and people's higher needs for rehabilitation, new approaches to visual training for these diseases with visual field defects are emerging. Currently, visual rehabilitation training for patients with visual field defects focuses on two directions: central visual field defects and hemianopia/peripheral visual field defects. Patients' fine vision is mainly affected by central visual field defects, the rehabilitation training for which can be divided into eccentric viewing training, eye movement training and perceptual learning training. Patients' visual exploration, orientation, walking and reading are largely influenced by hemianopia and peripheral visual field defects, the rehabilitation training for which can be separated into visual restoration strategy and eye movement compensatory strategy.(Chin J Ophthalmol, 2015, 51: 552-556)